Billing

Denial Management

The systematic process of identifying, analyzing, and resolving denied insurance claims to recover lost revenue.

In Detail

Denial management involves tracking denial patterns, categorizing denial reasons (clinical, technical, administrative), appealing denied claims, and implementing preventive measures. Common PT denial reasons include: lack of medical necessity (CO-50), timely filing (CO-29), duplicate claims (CO-18), and authorization issues (CO-15). PRACTIS reduces denial rates by 41% through AI-powered pre-submission scrubbing and auto-generates appeal documentation for denied claims.

Related Search Terms

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Related Terms

Appeal

A formal request to an insurance company to reconsider a denied claim or prior authorization decision.

Clean Claim Rate

The percentage of claims submitted that are accepted by the payer on the first submission without errors or additional information required.

Revenue Cycle Management (RCM)

RCM

The end-to-end financial process of managing claims, payments, and revenue generation from patient registration through final payment collection.

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